Provider Demographics
NPI:1740487305
Name:WHITE, STEPHEN AULTON (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:AULTON
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 TREEMONT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2874
Mailing Address - Country:US
Mailing Address - Phone:931-552-3031
Mailing Address - Fax:931-647-9820
Practice Address - Street 1:2289 RUDOLPHTOWN RD STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2231
Practice Address - Country:US
Practice Address - Phone:931-552-3031
Practice Address - Fax:931-647-9820
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD014198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3822301Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE